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This Viewpoint considers the best approaches for treating obesity in youth and argues that better funding is needed for new dietary treatments and reimbursement for behavioral interventions. [ABSTRACT FROM AUTHOR]

The article presents information on the medical research conduction on dietary composition and its effects on the energy expenditure during weight-loss maintenance with respect to the macronutrient composition and the glycemic load. The Children's Hospital and the Women's Hospital in Boston, Massachusetts conducted the research and controlled trials on obese young adults which involved the consumption of isocaloric low-fat diet, low-glycemic index diet and a very low-carbohydrate diet. Information on the results of the research that involves the resting energy expenditure, total energy expenditure, metabolic syndrome components and hormone levels is also presented.

A conference paper about the physical and psychosocial complications of obese adolescents as illustrated by the case of a 14-year-old girl with a body mass index of 40, is presented. It assesses the effectiveness of pediatric obesity treatment and describes novel strategies to alter energy balance. It also explains the important role that parents should play on weight behaviors of their adolescents. In addition, it details behaviors that may promote successful long-term weight management.

The authors question whether the food industry can play a constructive role in fighting the obesity epidemic. They cite the results of a report by A. Lewin which found discrepancies in the promises and the actual practices of the McDonald's restaurant and the Kraft food company. The authors believe that a market-driven economy causes industry to act in the interest of maximizing profit and that society cannot depend on the food industry to address obesity voluntarily.

Context: The results of clinical trials involving diet in the treatment of obesity have been inconsistent, possibly due to inherent physiological differences among study participants.Objective: To determine whether insulin secretion affects weight loss with 2 popular diets.Design, Setting, and Participants: Randomized trial of obese young adults (aged 18-35 years; n = 73) conducted from September 2004 to December 2006 in Boston, Mass, and consisting of a 6-month intensive intervention period and a 12-month follow-up period. Serum insulin concentration at 30 minutes after a 75-g dose of oral glucose was determined at baseline as a measure of insulin secretion. Outcomes were assessed at 6, 12, and 18 months. Missing data were imputed conservatively.Interventions: A low-glycemic load (40% carbohydrate and 35% fat) vs low-fat (55% carbohydrate and 20% fat) diet.Main Outcome Measures: Body weight, body fat percentage determined by dual-energy x-ray absorptiometry, and cardiovascular disease risk factors.Results: Change in body weight and body fat percentage did not differ between the diet groups overall. However, insulin concentration at 30 minutes after a dose of oral glucose was an effect modifier (group x time x insulin concentration at 30 minutes: P = .02 for body weight and P = .01 for body fat percentage). For those with insulin concentration at 30 minutes above the median (57.5 microIU/mL; n = 28), the low-glycemic load diet produced a greater decrease in weight (-5.8 vs -1.2 kg; P = .004) and body fat percentage (-2.6% vs -0.9%; P = .03) than the low-fat diet at 18 months. There were no significant differences in these end points between diet groups for those with insulin concentration at 30 minutes below the median level (n = 28). Insulin concentration at 30 minutes after a dose of oral glucose was not a significant effect modifier for cardiovascular disease risk factors. In the full cohort, plasma high-density lipoprotein cholesterol and triglyceride concentrations improved more on the low-glycemic load diet, whereas low-density lipoprotein cholesterol concentration improved more on the low-fat diet.Conclusions: Variability in dietary weight loss trials may be partially attributable to differences in hormonal response. Reducing glycemic load may be especially important to achieve weight loss among individuals with high insulin secretion. Regardless of insulin secretion, a low-glycemic load diet has beneficial effects on high-density lipoprotein cholesterol and triglyceride concentrations but not on low-density lipoprotein cholesterol concentration.Trial Registration: clinicaltrials.gov Identifier: NCT00130299. [ABSTRACT FROM AUTHOR]

Context: Weight loss elicits physiological adaptations relating to energy intake and expenditure that antagonize ongoing weight loss.Objective: To test whether dietary composition affects the physiological adaptations to weight loss, as assessed by resting energy expenditure. DESIGN, STUDY, AND PARTICIPANTS: A randomized parallel-design study of 39 overweight or obese young adults aged 18 to 40 years who received an energy-restricted diet, either low-glycemic load or low-fat. Participants were studied in the General Clinical Research Centers of the Brigham and Women's Hospital and the Children's Hospital, Boston, Mass, before and after 10% weight loss. The study was conducted from January 4, 2001, to May 6, 2003.Main Outcome Measures: Resting energy expenditure measured in the fasting state by indirect calorimetry, body composition by dual-energy x-ray absorptiometry, cardiovascular disease risk factors, and self-reported hunger.Results: Resting energy expenditure decreased less with the low-glycemic load diet than with the low-fat diet, expressed in absolute terms (mean [SE], 96 [24] vs 176 [27] kcal/d; P = .04) or as a proportion (5.9% [1.5%] vs 10.6% [1.7%]; P = .05). Participants receiving the low-glycemic load diet reported less hunger than those receiving the low-fat diet (P = .04). Insulin resistance (P = .01), serum triglycerides (P = .01), C-reactive protein (P = .03), and blood pressure (P = .07 for both systolic and diastolic) improved more with the low-glycemic load diet. Changes in body composition (fat and lean mass) in both groups were very similar (P = .85 and P = .45, respectively).Conclusions: Changes in dietary composition within prevailing norms can affect physiological adaptations that defend body weight. Reduction in glycemic load may aid in the prevention or treatment of obesity, cardiovascular disease, and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Context Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes, but these relationships have been minimally addressed in adults. Objective To examine the association between consumption of sugar-sweetened beverages and weight change and risk of type 2 diabetes in women. Design, Setting, and Participants Prospective cohort analyses conducted from 1991 to 1999 among women in the Nurses' Health Study II. The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991. The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991, 1995, and 1999. We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up. Main Outcome Measures Weight gain and incidence of type 2 diabetes. Results Those with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month. Similarly, consumption of fruit punch was associated with increased diabetes risk (RR for ≥... [ABSTRACT FROM AUTHOR]

Context Fast food consumption has increased greatly among children in recent years, in tandem with the obesity epidemic. Fast food tends to promote a positive energy balance and, for this reason, may result in weight gain. However, if fast food and obesity are causally related, the question arises of why some children who frequently eat fast food do not become overweight. Objective To test the hypothesis that overweight adolescents are more susceptible to the adverse effects of fast food than lean adolescents. Design and Setting In study 1, we fed participants an "extra large" fast food meal in a naturalistic setting (a food court). The participants were instructed to eat as much or little as desired during this 1-hour meal. In study 2, we assessed energy intake under free-living conditions for 2 days when fast food was consumed and 2 days when it was not consumed. Data were collected in Boston, Mass, between July 2002 and March 2003. Participants Overweight (n = 26) and lean (n = 28) adolescents aged 13 to 17 years. Overweight was defined as a body mass index exceeding sex- and age-specific 85th percentiles based on the 2000 Centers for Disease Control and Prevention growth charts. Main Outcome Measures Energy intake determined by direct observation in study 1 and by unannounced 24-hour dietary recalls, administered by telephone, in study 2. Results In study 1, mean (SEM) energy intake from the fast food meal among all participants was extremely large (1652 [87] kcal), accounting for 61.6% (2.2%) of estimated daily energy requirements. Overweight participants ate more than lean participants whether energy was expressed in absolute terms (1860 [129] vs 1458 [107] kcal, P = .02) or relative to estimated daily energy requirements (66.5% [3.1%] vs 57.0% [2.9%], P = .03). In study 2, overweight participants consumed significantly more total energy on fast food days than non–fast food days (2703 [226] vs 2295 [162] kcal/d; +409 [142] kcal/d; P = .02), an effect... [ABSTRACT FROM AUTHOR]

The glycemic index was proposed in 1981 as an alternative system for classifying carbohydrate-containing food. Since then, several hundred scientific articles and numerous popular diet books have been published on the topic. However, the clinical significance of the glycemic index remains the subject of debate. The purpose of this review is to examine the physiological effects of the glycemic index and the relevance of these effects in preventing and treating obesity, diabetes, and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Context: Components of the insulin resistance syndrome (IRS), including obesity, glucose intolerance, hypertension, and dyslipidemia, are major risk factors for type 2 diabetes and heart disease. Although diet has been postulated to influence IRS, the independent effects of dairy consumption on development of this syndrome have not been investigated. Objective: To examine associations between dairy intake and incidence of IRS, adjusting for confounding lifestyle and dietary factors. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective study. Setting and Participants: General community sample from 4 US metropolitan areas of 3157 black and white adults aged 18 to 30 years who were followed up from 1985-1986 to 1995-1996. Main Outcome Measure: Ten-year cumulative incidence of IRS and its association with dairy consumption, measured by diet history interview. Results: Dairy consumption was inversely associated with the incidence of all IRS components among individuals who were overweight (body mass index ≥25 kg/m[sup 2]) at baseline but not among leaner individuals (body mass index <25 kg/m[sup 2]). The adjusted odds of developing IRS (2 or more components) were 72% lower (odds ratio, 0.28; 95% confidence interval, 0.14-0.58) among overweight individuals in the highest (≥35 times per week, 24/102 individuals) compared with the lowest (<10 times per week, 85/190 individuals) category of dairy consumption. Each daily occasion of dairy consumption was associated with a 21% lower odds of IRS (odds ratio, 0.79; 95% confidence interval, 0.70-0.88). These associations were similar for blacks and whites and for men and women. Other dietary factors, including macronutrients and micronutrients, did not explain the association between dairy intake and IRS. Conclusions: Dietary patterns characterized by increased dairy consumption have a strong inverse association with IRS among overweight adults and may... [ABSTRACT FROM AUTHOR]

Examines the physiology of type 2 diabetes mellitus and examines issues of public health and reviews prevention and treatment strategies. Epidemiology; Natural history; Complications; Diagnosis; Prevention and treatment; Conclusion that primary health care clinicians must play an active role in both the primary prevention of obesity and the timely diagnosis and treatment of type 2 diabetes mellitus.

Offers the results of a study on the intake of dietary fiber and its effect on weight gain and cardiovascular disease (CVD) risk in young adults. How dietary composition may affect insulin secretion which in turn increases the risk for CVD; Context; Objective; Design and setting; Participants; Main outcome measures; Results; Conclusions.

This Viewpoint discusses methodological challenges to conducting reliable dietary research relative to processes and standards in place for drug discovery and development, and proposes modifications to the conduct of dietary research to improve its transparency, quality, and reliability. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "State intervention in life-threatening childhood obesity," by L. Murtagh and D. S. Ludwig.

The authors express their opinion that the U.S. economic crisis could provide opportunity by launching a national obesity initiative and laying the foundation for economic well-being. The origins of the obesity epidemic are examined. The effect of obesity on the economy and the effect of the recession on obesity are discussed. A list of specific projects that could comprise a long-term public health strategy is presented.

The authors discuss the importance of biodiversity in the advancement of medicine and research. The increased interest in probiotics is discussed. Discoveries based on nature's response to challenges are also presented. A table listing drugs derived from nature is included. The authors believe physicians have a responsibility for preventing loss of biodiversity. They note the need for energy conservation and improved waste management in reducing biodiversity loss.

The authors comment on mindfulness in medicine. They suggest that mindfulness, which is a meditation practice, involves attending to relevant aspects of experience in a nonjudgmental manner and that in the past thirty years interest in the therapeutic use of mindfulness has increased. They argue that the original purpose of mindfulness in Buddhism, which is to alleviate suffering and cultivate compassion, suggests a potential role for its practice with medical patients and practitioners.

The author discusses the outcomes of the low-fat diet in the U.S. since the mid-20th century. He explores the fat contents of a variety of foods such as sauces and salad dressings. He also compares the physiological effects of low-fat and high-fat foods and the focus on replacing dietary fat with carbohydrate.

The author reflects on data suggesting that the lifespan in the U.S. may decline by the mid-21st century due in part to obesity and other chronic-diet related disease. He comments on the need for long-term trials on approaches to weight control as well as new perspectives on the public health approach to obesity. The author also suggests that health care professional model healthy behavior and discuss diets more routinely.

A response from the authors of the article "The 2015 US Dietary Guidelines: lifting the ban on total dietary fat" that was published in the 2015 issue is presented.

The authors present insights on the "Dietary Guidelines for Americas," released by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. They discuss the revision process of the guidelines by the Dietary Guidelines Advisory Committee, the elimination of dietary cholesterol as a nutrient of concern and the absence of an upper limit on total fat consumption.

The authors expresses their views on the benefits of government taxes and subsidies to improve the public health services in the U.S. One of the author mentions the increasing costs for medical care services in the country which has prioritized medications, devices and procedures to treat diseases rather on preventive measures. The other author also emphasizes on the purpose of taxes and subsidies to improve public dietary patterns.

The authors consider whether adiposity is a consequence or cause of overeating. Topics discussed include the short-term weight change produced from voluntary changes in calorie intake, the relationship between metabolic fuel concentration and hunger, and the merits of focusing on diet composition for weight loss.

The author reflects on the health effects of fructose. He argues that if high dose of fructose was toxic, then people consuming large amounts of fruits might experience adverse effects. According to him, the absence of harm from fruit consumption links to the slow digestion rate of fruit compared with a sugar-sweetened beverage that produces fructose concentrations. He opines that fructose in its natural form is not linked with adverse effects up to the limits of consumption.

The authors' looks at the changes required in public health programs to reduce the increase in number of gun violence cases. They mentions that tobacco and illicit drugs user forms major part of convicts associated with gun violence and health awareness and counseling program should be organized to educate against the potent misuse of drugs. They highlights that amendments are required in minimum age limit for grant of ownership rights to citizens for possession of guns and ammunition.

The article offers information on the ways to reduce hunger and obesity among children in low-income families. According to a study conducted on mice, intermittent fasting developed increased body weight and fatness compared with animals with predictable food availability. It mentions that the Supplemental Nutrition Assistance Program (SNAP), a 75 U.S. billion dollars annual federal food assistance program, provides a critical opportunity to improve the nutritional health of children in the U.S. It further states that SNAP is essential for hunger prevention in the country but its exclusive focus on food quantity contributes to malnutrition and obesity among children.

Several letters to the editor are presented in response to the articles in previous issues including a crossover trial conducted for examining the energy expenditure during weightloss maintenance with a low-fat, a low-glycemic index and a very low-carbohydrate diet, understanding of dietary modulation for energy expenditure and dietary composition for preventing daily calorific imbalance and it also present a reply in the same issue.

The authors discuss the impact of bariatric surgery on diabetes remission and weight loss. It informs that the type 2 diabetes is prevented by adhering to a low-risk lifestyle including a prudent diet, moderate-intensity physical activity and normal body weight. It is concluded that, as the conventional low-intensity lifestyle treatment of type 2 diabetes do not provide enough glycemic control, surgical methods are considered which causes morbidity including bowel obstruction.

The article looks at the decision of the U.S. Department of Agriculture (USDA) to reject a request by the state of New York to conduct a pilot study seeking to eliminate Supplemental Nutrition Assistance Program (SNAP) benefits for sugar-sweetened beverages. New York contended that consumption of such beverages causes obesity and diabetes. The agency expressed concern that granting the request may stigmatize SNAP recipients. The authors note the need for objective data to inform policy change.

The author comments on state intervention in life-threatening childhood obesity in the U.S. According to the author, parents have the constitutional right to raise their children as they choose, but the state may intervene to safeguard the child's interests. State protective services may include placement into foster care. The author believes that the government will eventually reduce the need for such interventions through investments in the social infrastructure and policies to enhance diet and encourage physical activity among children.

The author looks at the developments in food technology and the implications of which for human nutrition and health. He tackles the three food technology revolutions which include the development of stone tools for food preparation in the Paleolithic era, the Agricultural Revolution and the Industrial Revolution in the 19th century. He notes that a diet based on ultraprocessed products may contribute to obesity and development of chronic disease. He suggests to use food technology more appropriately by focusing on public health.

The authors argue in favor of food-based approach for prevention of chronic diseases. They present a background of the development of modern nutritional science and the emergence of dietary guidelines in the age of chronic disease. They examine the disadvantages of nutrient-deficiency based approach for chronic disease prevention and emphasize the need for a new approach. The authors also cite the role of modern nutritional science in developing and promoting healthier food-based dietary patterns to improve public health.

The authors comment on the need to consider home economics education as part of any long-term solution to pediatric obesity epidemic and concerns over the poor diet quality of adolescents in the U.S. They note the limited success of programs aimed at addressing this epidemic. They point out that there is broad consensus about the benefits of home-prepared meals. They also contend that a home economics coursework should aim to transform meal preparation from an intimidating chore to a manageable and rewarding pursuit.

The authors reflect on the policy of the U.S. Food and Drug Administration requiring food products to have front-of-package labels of nutrition and health claims. They claim that front-of-package labels could thoroughly mislead the public and suggest its elimination and instead strengthen the Nutrition Facts Panel. They cite ways on how front-of-package labels mislead the public, including claims based on individual nutritional factor. They also suggest that health claims on food packages should be regulated more strictly.

The authors examine the physiology of weight gain and loss and estimate the amount of reduction of caloric intake necessary to avoid becoming overweight or obese. They describe how weight change can be self-limiting. They describe the weight gain of a person who consumes an extra cookie everyday. They note that a small decrease in food intake or increase in physical activity will only halt weight gain temporarily. They believe that an effective health approach to obesity prevention requires fundamental changes in food supply and social infrastructure.

The author reflects on the health implications of artificially sweetened beverages. He discusses the physiological transport and impact of sugar and artificial sweeteners, including cancer risk. He explains the health-related problems brought by the large consumption of refined and concentrated sugars, particularly sugar-sweetened beverages. The author argues that more research is needed to understand the health effects of sweetened drinks and diet drinks.

The authors propose four criteria to evaluate the efficacy of governmental action in addressing public health problems in the U.S. Such criteria include plausibility, science, potential benefits compared to costs, and the relation between government intervention and societal values and goals. The authors explained how such criteria can be applied to calorie labeling regulation for restaurants. They argued that the criteria they proposed is relevant in implementing public health interventions.

The article presents a letter to the editor in response to the article "Nutritively sweetened beverage consumption and obesity: the need for solid evidence on a fluid issue" by D. B. Allison and R. D. Mattes published in a 2009 issue.

The article examines several issues related to the use of body mass index (BMI) to to evaluate the impact of childhood obesity. Obesity is defined as having a BMI in the 95th percentile, yet the percentiles derive from data compiled prior to a significant increase in pediatric body weights. The usefulness of BMI in predicting obesity-related illness is also questioned, since BMI says nothing about several key data such as body composition and fat distribution. Confounding variables are also discussed, as are racial and ethnic considerations.

This editorial comments on a study in this issue about maintaining weight loss in children who suffer from obesity. The author discusses how adult weight loss and children weight loss differ. The fact that the study showed a decrease in success over time makes the author believe that the failures in adult dieting might be passed on the children. The author calls for research into finding the best dietary and exercise regime and behavior modification tools to treat obese children.

Presents a letter to the editor in response to the article "Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss," in a previous issue of JAMA.

Presents a reply by Matthias B. Schulze, JoAnn E. Manson, Graham A. Colditz, Meir J. Stampfer, Walter C. Willett, Frank B. Hu, and David S. Ludwig to a letter to the editor about their article "Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women."

A letter to the editor is presented in response to the article "The Supplemental Nutrition Assistance Program, Soda and the USDA Policy: Who Benefits?," by K. D. Brownell and colleagues which appeared in a 2011 issue.

A response by David S. Ludwig and Harold A. Pollack to a letter to the editor about their article "Obesity and the Economy: From Crisis to Opportunity" in a 2009 issue of the "Journal of the American Medical Association" is presented.